Written by a Medical Acupuncture for Veterinarians course graduate. Author’s name available upon request. Signed release obtained from client/author/4983.
Case History: Equine patient presented for chronic, multiple limb lameness with the left hind (LH) limb being the most affected as a grade 4 of 5 on the American Association of Equine Practitioners (AAEP) grading scale.
Summary of Results: A course of 7 treatments with a combination of 5 dry needle acupuncture and 2 Electroacupuncture (EAC) treatments yielded improved cranial phase of the LH gait, decreased slapping aspect to LH gait, and resolution of LH toe drag. No significant difference was appreciated in gait quality following 2 EAC sessions. The farrier reported patient stood better for being shod on all 4 limbs one hour following the 1st acupuncture treatment. Additionally, 1 week following the 7th acupuncture treatment, patient was reshod and farrier reported that was the best patient has stood for shoeing over the past year, including the sessions where patient received phenylbutazone (Bute) prior to shoeing.
25 year old chestnut Arabian mare with multiple limb lameness referred to me for acupuncture evaluation and treatment. History of surgical repair for a distal second phalanx chip fracture of the right hind approximately 10 years ago. About 5 years ago, based on history of acute LH lameness, site of swelling near left tuber coxae, and palpation, attending Doctor of Veterinary Medicine (DVM) suspected a left hip injury. Patient was no longer serviceably sound following this hip injury. Diagnosed with left front (LF) carpal arthritis about 3.5 years ago. Annual LF carpal and LH stifle joint injections have been performed for the past 2 years. However, little improvement was seen following the last carpal joint injection. Diagnosed with bilateral hindlimb Degenerative Suspensory Ligament Disease (DSLD) about 6 months ago. Owner also reports that patient has difficulty standing for the farrier when being shod. Patient receives daily oral CosequinASU, monthly intravenous (IV) Legend, and ¼ tablet Previcox orally every other day for over 1 year for general arthritis management.
Physical Examination and Clinical Assessments:
Multiple limb lameness, with most notable grade 4 of 5 LH lameness with shortness of the cranial phase of the stride, a slapping/”goose-stepping” deficit to the gait, and a consistent toe drag visible at the walk.
– Left side: Mild sensitivity to palpation along the cervical region, most notable at BL 10 and at the cervicothoracic junction. Mild to moderate sensitivity to palpation and mild to moderate taught bands along triceps. Moderate sensitivity and moderate taught bands along inner bladder line. Severely taught muscle bands and moderate sensitivity to palpation surrounding tuber coxae and gluteal muscles.
-Right side: Less sensitivity to palpation compared to left. Cervical region and shoulder region had mildly taught bands similar to the left, but less sensitive to palpation. Mild to moderate taught bands along epaxial muscles, tuber coxae, and gluteal muscles, but less sensitive to palpation.
Medical Decision Making:
Based on lameness exam findings and myofascial palpation, the main area of treatment focus was the left hip region (muscles cranial, dorsal, and caudal to the tuber coxae). Other areas that were commonly found to be tight and sore on myofascial exam were epaxial muscles, triceps, and cervical muscles, in descending order of degree of soreness and taughtness on examination. The gait of the LH was the most obvious gait deficit and was therefore selected as a high priority region to treat. Additionally, the noticeable LH gait deficits allowed both client and myself to use as a marker for treatment response.
-Treatment points were based on myofascial palpation. Patient tolerated 13 minutes of dry needle acupuncture on her 1st treatment and subsequent treatments were 20 minutes. Electroacupuncture (EAC) was initiated on the 4th and 5th sessions. 2 leads were used for EAC and connected along Bai Hui and left hip triad. The highest frequency patient tolerated was 5.5Hz for 5 minutes. No EAC was done on the 6th session to assess if EAC significantly affected LH lameness.
-Cervical and cervicothoracic region: BL 10 was treated bilaterally every week after the 2nd session when the patient had become accustomed to acupuncture treatment. LI 15 and 16 were treated weekly on the left side. GB 21 was treated bilaterally weekly to use as a calming point.
-Shoulder: On a weekly basis, SI 9, 10, 11 and TH 12 and 13 were treated bilaterally.
-Back: Left side BL 19-21 were treated weekly. Bai Hui was treated weekly. BL 19-21 were treated at the first 2 treatments on the right side and then treatment of that location varied depending on weekly myofascial palpation.
-Hip: Hip triad bilaterally weekly (BL 54, GB29, GB30). BL 25-29 on the left side weekly. Many local points were added in subsequent treatments on the left side near the tuber coxae and gluteal region, depending on palpation findings.
Outcome, Discussions, and References:
In this case, the goal was to improve overall patient comfort and address a multiple limb lameness with a whole body approach. The left front lameness improved slightly with acupuncture treatment, potentially addressing shoulder compensation. The most significant improvement from treatment was in the LH as acupuncture lead to significant improvement in limb function. The tuber coxae region has a group of large muscles in the horse and is a region relatively close to the lumbosacral spinal cord nerve roots and is likely a contributing factor in patient’s positive response to acupuncture of this region. However, the lack of significant response to EAC in comparison to dry needle acupuncture is suggestive that the patient’s LH gait deficits and discomfort during shoeing may be more myofascial in origin than neuropathic. The observation that the patient stood better for shoeing than when Bute was administered suggests that acupuncture is instrumental in helping with myofascial and nerve discomfort as Bute’s anti-inflammatory properties may not have addressed this aspect of patient’s discomfort.
- Zhang, R. et al. Mechanisms of Acupuncture-Electroacupuncture on Persistent Pain. Anesthesiology. 2014 Feb; 120(2):482-503
- Leonid Kalichman and Simon Vulfsons. Clinical Review: Dry Needling in the Management of Musculoskeletal Pain. J Am Board Fam Med September-October 2010 23 no. 5 640-646
- Hong, Chang-Zern. Myofascial Trigger Points: Pathophysiology and Correlation with Acupuncture Points. Acupunct Med 2000;18:41-47